Panaritium is a purulent inflammation of the soft tissues and bones of the finger. Depending on the location of the purulent focus and the depth of the inflammatory process, cutaneous, subcutaneous, subungual, articular, tendon, bone panaritium, pandactylitis and paronychia are distinguished.
Cutaneous panaritium is an abscess located under the epidermis of the skin. In the case of nail felon, depending on the location and distribution, three forms are distinguished: paronychia and subungual felon. Paronychia is a purulent inflammation of the cushion surrounding the nail. Subungual panaritium is an accumulation of pus under the nail. Subcutaneous panaritium is a purulent inflammation subcutaneous tissue phalanges of fingers. The favorite localization of the subcutaneous panaritium is the palmar side of the terminal phalanx of the finger. Tendon felon is the most severe and disabling form of purulent inflammation of the fingers, which is accompanied by damage to the tendon sheath and death of the finger tendon. Bone and articular felon occur primarily when there is a deep wound to the bone and joint cavity or when inflammation spreads from surrounding tissues as a complication of subcutaneous felon. In cases where purulent inflammation covers the entire thickness of the finger, they speak of pandactylitis.
Causes of panaritium.
Any panaritium is caused by visible or unnoticed microtrauma: an injection, a scratch, a foreign body (for example, a splinter, glass wool, glass, metal shavings and others), abrasion, wounds during manicure.
The causative agent of the disease penetrates through the resulting skin damage. Bacteria primarily cause felon Staphylococcus aureus, as well as streptococci and enterococci. Less commonly, purulent inflammation develops with the participation of Escherichia coli, Pseudomonas aeruginosa, and Proteus.
Predisposing factors for the development of panaritium are diabetes mellitus, impaired blood supply to the hand, vitamin deficiency and immunodeficiency. In such cases, the purulent process develops faster, is more severe and difficult to treat.
The specificity of the symptoms of felon and the nature of the course of the purulent process are due to the peculiar anatomy of the fingers. The fact is that the skin of the palmar surface of the fingers is tightly fixed to the underlying structures and bones by dense connective tissue partitions, forming a large number of closed cells with subcutaneous fatty tissue. Subcutaneous fat is a favorable environment for the proliferation of microorganisms. Therefore, when the skin is damaged and such a cell with a nutrient medium becomes infected, the purulent process does not spread along the finger, but in depth towards the tendon and bone. This is why bursting and shooting pains in the finger occur early. The skin of the dorsal surface of the fingers, on the contrary, is loosely connected to the underlying structures, so swelling is easier to develop on the dorsum of the fingers, often distracting from the main cause of the disease.
Symptoms of felon.
Depending on the type of panaritium, the clinical manifestations will be different.
Intradermal panaritium occurs most easily. It looks like a bubble filled with pus, most often located on the palmar surface of the terminal phalanx. I am concerned about moderate pain and a feeling of fullness in the area of the bladder.
With paronychia that occurs after a manicure, inflammation of the nail fold occurs, which becomes swollen, red and painful. As inflammation continues, the skin of the cushion rises and becomes whitish - pus can be seen through it. Pain with paronychia varies from aching to constant, pulsating in the stage of abscess formation. Pus may spread under the nail plate to form a subungual panaritium, the main symptom of which will be the detachment of part or all of the nail plate with pus.
Subcutaneous panaritium is accompanied by thickening of the affected phalanx of the finger, the skin turns red and shiny. Full movements become impossible due to throbbing pain that intensifies when lowering the arm.
With tendon panaritium, thickening and redness of the entire finger are observed, movements are sharply painful. The finger becomes sausage-shaped and is in a semi-bent state. The pain is severe and pulsating. Swelling may spread to the back of the hand and palmar surface. The purulent process progresses quite quickly, spreading after the swelling to the hand and even forearm. Typical symptoms tendon panaritium are shown in the photo below.
With articular and bone panaritium, the joint and bone of the phalanx of the finger are involved in the purulent process. The symptoms of bone and articular felon are similar to those of subcutaneous felon, but more pronounced. The swelling usually spreads throughout the finger. The pain is strong, intense and cannot be clearly localized, the finger is bent, movements are impossible due to pain and swelling. Spontaneous breakthrough of pus through the skin with the formation of purulent fistulas is possible. In the case of articular panaritium, swelling, redness and pain are initially localized around the affected joint, but if left untreated, they spread to the entire finger. A typical clinical picture is shown in the photo.
Examination for felon.
If you notice these symptoms, you should consult a surgeon at the clinic. In the case of paronychia, cutaneous and subcutaneous panaritium, the diagnosis is made based on the clinical picture and additional instrumental examination does not require. Enough to pass general analysis blood and blood glucose to determine the severity of the inflammatory process and diagnosis diabetes mellitus, and, if present, the severity of the disease. In case of suspected bone and articular felon, as well as tendon felon (to exclude bone involvement in inflammatory process) it is necessary to perform an x-ray of the hand. You should be aware that the x-ray picture lags behind the clinical picture by 1 to 2 weeks. Therefore, the radiography should be repeated after the specified period of time.
Treatment of panaritium.
At the initial stages of development of the inflammatory process, it is possible conservative treatment as antibacterial therapy, baths with hypertonic salt solution and physiotherapeutic procedures. However, patients often skip this stage of inflammation and do not seek treatment. medical care.
A purulent process in the finger usually develops on the 3rd day after infection. This is evidenced by constant throbbing pain and an increase in body temperature above 37°C. The first sleepless night caused by pain is an indication for surgical treatment.
For cutaneous felon, the operation consists of excision of the epidermal bubble at the border with healthy skin, treatment with a 3% solution of hydrogen peroxide and brilliant green. This manipulation can be performed at home with sharp nail scissors, after leaving them for 10 minutes in 70% ethyl alcohol for sterilization. The procedure is absolutely painless and does not require anesthesia. However, there is a danger of the existence of a felon in the form of a cufflink, when in the bottom of the bladder there is a fistula opening that goes under the skin. In this case, along with cutaneous felon, there is also subcutaneous felon. Therefore, excision of the exfoliated epidermis without surgical treatment subcutaneous felon will clearly not be enough for recovery, which will lead to the progression of purulent inflammation.
In case of paronychia, the formed abscess is opened by lifting the skin ridge at the base of the nail. If pus penetrates under the nail, then its exfoliated part is removed.
For subcutaneous panaritium, 2 lateral incisions are made at the border with the palmar surface of the skin, through which through drainage is carried out in the form of a gauze turunda and a rubber outlet. They prevent edges from sticking together postoperative wound, which is necessary for adequate drainage of pus and washing of the purulent cavity during dressings.
Paronychia, cutaneous and subcutaneous panaritium are treated in a clinic. If the diagnosis of tendon, bone and articular panaritium is confirmed, treatment is necessary in a purulent surgical infection department.
At the initial stage, partial treatment of the purulent focus is performed, as with subcutaneous panaritium. Subsequently, individual treatment is carried out.
Antibacterial therapy of felon in outpatient setting comes down to taking drugs such as ciprolet 500 mg 2 times a day for 7 days or amoxiclav 625 mg 3 times a day for 7 days.
Prevention of panaritium.
To prevent the development of panaritium, it is very important to properly treat the resulting hand wound in a timely manner. If you receive microtrauma to your hand, you should wash your hands with soap and remove foreign bodies from a wound (splinter, metal shavings, glass, etc.), squeeze a drop of blood from the wound, treat with a 3% hydrogen peroxide solution, lubricate the edges of the wound alcohol solution iodine or brilliant green. Cover with a bactericidal patch or sterile cloth.
When performing a manicure, you should avoid damaging the skin; before performing the procedure, treat the cuticle and adjacent skin with 70% alcohol. Nail clippers should also be immersed in 70% ethyl alcohol for 5-10 minutes. If the skin is damaged, it should be treated ethyl alcohol and avoid contaminating it with soil, when cutting meat, and so on.
Complications of panaritium.
With advanced panaritium, inflammation may spread to deeper tissues with the development of pandactylitis. The latter is difficult to treat and often leads to amputation of the finger. The transition of purulent inflammation to the tendon and the lack of timely surgical treatment causes necrosis of the tendon with loss of active movements in the finger. Along the tendon sheath, the purulent process quickly spreads to the hand with the development of phlegmon of the hand, the treatment of which requires extensive surgical interventions.
Articular panaritium often leads to the formation of contractures and stiffness in the affected joint.
Bone panaritium often leads to the development of chronic osteomyelitis of the finger with a recurrent course, accompanied by partial or complete loss of mobility.
Therefore, self-medication for felon is dangerous and can lead to tragic consequences. A positive outcome for this disease is only possible if you seek medical help early. Take care of your health. It is better to overestimate the severity of your symptoms than to seek medical help late.
Surgeon Tevs D.S.
Panaritium is a purulent inflammation of the tissues of the finger, less commonly the foot. In most cases, fingers I, II, and III are affected. According to statistics, people aged twenty to fifty years are more likely to suffer from panaritium, which is associated primarily with active labor activity. Thus, approximately 75% of cases of the disease are caused by work-related injury and only 10% by domestic injury, 15% are caused by other causes. It is worth noting that felon often occurs in early childhood. And it is not surprising, because children are very inquisitive, active and often receive micro-injuries to the skin.
Table of contents:Causes of panaritium
Purulent inflammation in tissues is caused by pathogenic and opportunistic bacteria: staphylococcus, streptococcus, enterococcus, Proteus or Pseudomonas aeruginosa. Microorganisms get deep into the tissues of the finger through all kinds of cuts, puncture wounds, splinters, bites, burns, and cracks. Concomitant factors also influence the development of purulent inflammation:
- Peripheral circulation disorders;
- Immunodeficiency states.
For working people, such aggravating factors are the influence of vibration, hypothermia, as well as exposure to irritating chemicals.
The skin of the palmar surface of the hand is tightly fused with the aponeurosis, their connection is ensured by fibrous bridges. The bridges form closed cells filled with fat cells. Thanks to this, the infection spreads deeper, rather than wider, into the hand. These anatomical features explain why purulent processes are predominantly localized on the palmar surface.
Symptoms of felon
Depending on the location of the purulent process, as well as its spread, the following types of felons are distinguished:
- Cutaneous;
- Subcutaneous;
- Subungual;
- Periungual (paronychia);
- Tendinous;
- Articular;
- Bone;
The first four forms are classified as superficial felon, the next four - to deep. At superficial forms diseases prevail in the clinical picture local symptoms, and general symptoms are mild. And deep forms of panaritium can greatly affect the general well-being of the patient.
Clinical manifestations depend primarily on the type of panaritium.
In this form of the disease, the purulent process is located within the skin. Often suppuration occurs in the epidermis, with pus raising the stratum corneum. As a result, a purulent bubble forms on the skin. The blister is surrounded by a narrow rim of hyperemia. Yellow pus is visible through the wall of the bladder. The pain with this form of panaritium is mild.
In this form of the disease, purulent inflammation is concentrated in the subcutaneous fat. The danger of subcutaneous panaritium is that pus from subcutaneous fat can spread to the tendon sheath, joints, and bones.
In most cases, the purulent process is concentrated in the area of the distal phalanx of the finger on the palmar surface. A couple of days, and sometimes several hours after receiving microtrauma, pain appears in this area, which then transforms into throbbing pain, especially worse at night, which disturbs sleep.
Often the patient develops regional lymphadenitis, weakness, and increased body temperature.
The boundaries of purulent inflammation are determined by the extent of pain detected when pressing on the affected area of the finger with the tip of tweezers.
In the area of pain, thickening and redness of the skin is determined. There may be slight swelling in the dorsum of the hand.
Infection of the periungual fold occurs due to existing hangnails caused by microtrauma during manicure. The purulent process seeps under the nail, thereby peeling it off from the nail bed. The periungual fold and the surrounding skin become edematous and swollen. Soreness is noted. When pressing on the affected area, pus appears on the surface of the skin. If you look closely, you can also see pus under the nail plate.
The process can be transformed into chronic form and drag on for weeks.
This form of the disease develops as a result of a splinter getting under the nail or infection of a hematoma formed as a result of a bruise in the nail area. A yellowish accumulation of pus is visualized under the nail plate, and local soreness is noted. In addition, redness and swelling in the area of the periungual fold are detected. The person is bothered by severe throbbing pain, noticeably worsening when lowering the arm.
Bacteria penetrate into the tendon sheath of the flexor finger when it is damaged by all kinds of wounding objects or due to the spread of purulent infection from the subcutaneous tissue. The appearance of purulent exudate in the tendon sheath provokes an increase in pressure there. Clinically this is manifested by the appearance severe pain. The danger is that increased pressure and effusion compress blood vessels, and this can lead to tendon necrosis. As a result, the functions of the finger are irreversibly impaired.
The purulent process from the tendon sheaths of the 1st and 2nd fingers can spread to the deep cellular space of the forearm. And isolated suppuration of the tendon sheath of the first finger can spread to the tendon sheath of the fifth finger; this phenomenon is called U-shaped.
Tendon panaritium occurs with severe throbbing pain. Pain occurs upon palpation along the tendon sheath. The affected finger is red, enlarged, half-bent, and when you try to straighten it, excruciating pain occurs.
This form of the disease occurs as a result of the introduction of microorganisms directly into the bone itself during injury, but more often as a result of the spread of a purulent process to the periosteum during subcutaneous felon.
Bone panaritium often affects the nail phalanx. The finger is slightly bent, the slightest movements lead to increased pain. Purulent effusion leads to compression of blood vessels, as well as detachment of the periosteum. As a result, necrosis of bone tissue occurs. Even after drainage of a purulent focus (operative or spontaneous), the inflammatory process can become chronic due to infected dead bone tissue. With a long course of the disease, the nail phalanx increases in volume and becomes club-shaped.
Bone panaritium occurs with intoxication symptoms in the form of weakness, fever, lymphadenitis.
This form of the disease develops as a result of infection of the joint cavity when a puncture wound is applied in this area or when a purulent process passes from the soft tissues or adjacent phalanx. It is noteworthy that the appearance of purulent effusion leads to the rapid destruction of elements of the articular apparatus. Therefore, complete restoration of joint function even after healing often does not occur.
Swelling and pain appear in the joint area, which soon spread to the entire finger. Due to the destruction of articular elements, pathological mobility joint, as well as crepitus during movements. The general well-being of a person also worsens: weakness, increased body temperature, and lymphadenitis appear.
This is the most severe form of the disease, affecting the skin, subcutaneous tissue, tendons, joints and bones. Develops as a complication of skin, joint, bone panaritium, which is possible if the patient does not consult a doctor in a timely manner or if there is common diseases, aggravating the course of felon.
The affected finger is greatly enlarged and even deformed. The skin of the finger is tense, cyanotic-purple, which indicates a severe circulatory disorder. The finger assumes a half-bent position. Often fistulas form on its surface, through which pus is released.
The patient feels severe weakness, there is an increase in temperature and lymphadenitis.
For superficial forms of felon in the initial stages, conservative treatment is possible with antibacterial agents and NSAIDs, physiotherapy, baths with hypertonic saline solution. Unfortunately, patients often do not consult a doctor during this period, hoping that the disease will go away on its own. But after a couple of days the purulent process gains momentum. Surgeons are guided by the rule of the first sleepless night, which goes like this: if the patient did not sleep at night due to pain in the finger, then it is time to operate.
The operation should be carried out as early as possible, since the spread of the purulent process deeper can lead to tissue necrosis.
With cutaneous panaritium, the surgeon removes the exfoliated layer of the epidermis with scissors, and then applies a bandage with an antiseptic.
With subcutaneous panaritium, the surgeon makes parallel incisions corresponding to the purulent focus, and on the nail phalanges - club-shaped incisions. After opening the abscess, the doctor excises the necrotic tissue and dissects the fibrous bridges to open the tissue cells. The cavity is drained through two incisions. Then a bandage is applied and the finger is immobilized in the required position.
To treat periungual felon, the purulent cavity is opened and necrotic debris is removed. soft fabrics periungual fold, then apply a bandage with an antiseptic. If pus has accumulated under the base of the nail, the nail plate is removed. After the operation, you need to apply bandages with ointment. The same is done for subungual felon.
Tendon panaritium can sometimes be treated conservatively by puncture of the tendon sheath with aspiration of purulent contents and administration of an antibiotic. But in most cases you still have to resort to surgical intervention. The surgeon makes parallel incisions on the proximal and middle phalanges, then opens the tendon sheath. The wound is washed and drained through. After surgery, the vagina is regularly washed with antiseptics. If the tendon dies, it is removed.
With bone felon, the surgeon makes longitudinal parallel incisions, removes necrotic soft tissue, as well as destroyed bone. In this case, the base of the phalanx must be preserved, since it is thanks to it that bone tissue regeneration is possible in the future. And with articular panaritium, the surgeon removes the affected joint with the prospect of creating arthrodesis in the future.
In case of pandactylitis, in order to save the finger, the surgeon removes fragments of bones and cartilage, as well as opening pockets and leaks with their drainage. But, unfortunately, in many cases it is necessary to amputate the finger.
Grigorova Valeria, medical observer
- This is a purulent inflammation of the bone structures of the finger. May be primary (less commonly) or secondary. The primary pathology is manifested by intense jerking pain and significant hyperthermia in combination with hyperemia, swelling and limitation of movements that occur a few days after a finger injury or against the background of a distant purulent process. Secondary bone panaritium develops as a result of the spread of infection in other forms of the disease, accompanied by low-grade fever and ongoing suppuration. Diagnosed based on examination, radiography, laboratory research. Surgical treatment - opening, curettage, bone resection. If there is significant bone destruction, amputation is indicated.
ICD-10
M86 Osteomyelitis
General information
Bone panaritium is a type of purulent inflammation of the tissues of the finger with bone damage (osteomyelitis). It is a fairly common pathology, according to various sources, ranging from 37 to 60% in the overall structure of purulent-inflammatory processes in the area of the fingers. Primary osteomyelitis of the phalanx is detected in only 5-10% of patients; in the remaining patients, secondary inflammation of the bone is observed. In the vast majority of cases (about 80%), the nail phalanx is affected. The disease is more often found in production workers with an increased likelihood of injury and intense contamination of hands with irritating substances - tractor drivers, mechanics, loaders, handymen, etc. The pathology can be diagnosed in all age groups, with a predominance of middle-aged patients.
Causes
The direct cause of bone panaritium is pyogenic bacteria, usually staphylococci, less often their association with other microorganisms, Pseudomonas aeruginosa, coli and coccal flora (enterococci, streptococci). The primary form develops with hematogenous introduction of infection from distant purulent foci and with paraosseous hematomas. The causes of the secondary purulent process are:
- Subcutaneous panaritium. It occurs in the predominant number of cases, which is associated with severe local intoxication, severe local circulatory disorders that occur when the tissue of the finger adjacent to the bone becomes inflamed. Most often affects the distal phalanx.
- Tendon and articular panaritium. Subcutaneous panaritium is less frequently detected in the anamnesis. Usually precedes purulent melting of the bones of the main and middle phalanges.
- Other forms of felon. In some cases, osteomyelitis of the distal phalanx is detected with paronychia, subungual or periungual panaritium, but such cases constitute a small proportion of the morbidity structure.
Due to the high probability of developing bone panaritium in the subcutaneous form of the disease in specialized literature There are indications that when suppuration of the tissue persists for two or more weeks, osteomyelitis should be considered as a natural result of inflammation of the soft tissues. Predisposing factors to purulent bone lesions for any etiology of the process are considered endocrine diseases, exhaustion, decreased immunity of various origins (with some diseases, chemical dependencies, taking hormonal drugs), metabolic disorders, trophic and microcirculatory disorders resulting from prolonged exposure to cold, vibration, moisture or irritating substances on the skin of the hands.
Pathogenesis
With hematogenous spread of infection, pyogenic microbes penetrate into the bone substance through the feeding vessels. The periosteum and medulla become inflamed, and sequestration is formed in the bone tissue. In secondary pathology, inflammation from the soft tissues spreads to the periosteum. The development of the purulent process is facilitated by pathological and physiological conditions, especially pronounced during inflammation of soft tissue structures in the area of the distal phalanges, in particular, a small volume of tissue, which causes the formation of a powerful focus of local infection, and severe violations local blood circulation in the periosteum area.
A feature of osteomyelitis of the phalanges of the fingers is the tendency to large-scale destruction of the periosteum. In osteomyelitis of other localizations, the periosteum reacts to inflammation by forming a so-called “bone box”, which provides the possibility of subsequent restoration of bone structures even if they are significantly destroyed. With a purulent process in the area of the phalanges, this does not happen; the periosteum quickly becomes necrotic, its regeneration becomes possible only after excision of the sequestrum. With significant melting of the remaining areas of the periosteum, it is not enough to restore and form full-fledged bone. This explains the low probability of cure and the need for amputations during a prolonged or extensive inflammatory process.
Classification
Taking into account the etiology, a distinction is made between primary (arising against the background of trauma or hematogenous) and secondary (contact with other types of disease) bone panaritium. Since osteomyelitis primarily affects distal phalanges, a classification has been developed that allows one to reasonably determine treatment tactics for this type of pathology. There are three types of damage to bone structures:
- Regional or longitudinal sequestration. Bone destruction is local in nature, the periosteum is slightly melted, possibly full recovery bones. In the presence of a marginal sequester, the mobility of the finger is preserved after recovery. With longitudinal sequestration, the process involves distal joint finger, the outcome is ankylosis.
- Sequestration with preservation of the base of the phalanx. The purulent process is localized above the base of the bone, the epiphysis is not changed. Independent blood supply to the epiphyseal and diaphyseal zones of the bone provides favorable conditions for its restoration with sufficient preservation of the periosteum. The decision to preserve or amputate a finger is made individually, taking into account the size of the sequestrum and the duration of the disease.
- Complete sequestration of the phalanx. The changed bone is surrounded on all sides by a cavity filled with pus. Suppuration spreads to the joint and tendon sheath. The periosteum is completely destroyed or small areas of it remain, incapable of full regeneration. Amputation required.
Symptoms of bone panaritium
With secondary damage, the distal phalanges of the 1st, 2nd and 3rd fingers are usually affected. Initially, a characteristic clinical picture of subcutaneous panaritium is observed, accompanied by local swelling, hyperemia, throbbing pain along the palmar surface of the finger, weakness, weakness, and increased temperature. Then a focus of suppuration forms in the affected area, which is independently opened onto the skin or drained by a purulent surgeon, local and general signs inflammation decreases. The spread of pus to the bone structures is manifested by a repeated intensification of symptoms, which in the initial stages of osteomyelitis, however, does not reach the degree of severity characteristic of subcutaneous panaritium.
With primary damage, panaritium develops acutely. The phalanx swells, the skin turns red and then becomes purple-bluish, and intense jerking pain occurs. The finger is in a forced flexion position; active and passive movements cause increased pain. There is significant general hyperthermia, body temperature sometimes reaches 40˚C, and chills are possible. With the progression of the primary and secondary process, a flask-shaped expansion of the finger is revealed. The skin on the affected phalanx is tense, smooth, and shiny. The phalanx is painful throughout. Areas of necrosis form. Fistulas are formed, usually located in the subungual zone. Deformations associated with the destruction of soft tissue and bone structures may occur.
Complications
In case of immunity disorders, incorrect or not timely treatment bone panaritium can develop into pandactylitis - inflammation of all tissues of the finger, including joints and tendons. In some cases, the purulent process spreads in the proximal direction. Possible phlegmon of the hand, deep phlegmon of the forearm, purulent arthritis of the wrist joint. In severe cases, sepsis develops, which poses a threat to the patient's life. The outcome is often contractures, stiffness or ankylosis caused by severe scarring, damage to nearby tendons and joints, and prolonged immobilization.
Diagnostics
The diagnosis is made by specialists in the field of purulent surgery when the patient visits the clinic, less often - during emergency hospitalization due to severe symptoms of the purulent process. In the diagnostic process, a characteristic anamnesis, a typical clinical picture of the disease and data are taken into account additional research. The survey plan includes the following activities:
- Questioning, inspection. In the primary process, a history of finger injury or the presence of a distant purulent focus is revealed. In the secondary version, it is established that the patient has suffered from another form of panaritium over the previous two or more weeks. Upon examination, swelling, redness and a fistula with purulent discharge are detected. With careful insertion of the probe, the eroded surface of the bone is determined.
- Radiography. X-ray sign The disease is an uneven clearing of the phalanx, caused by reactive osteoporosis, combined with erased contours, and later - eroded contours and a focus of destruction. Sometimes, as inflammation progresses, the bone is almost invisible on the x-ray of the finger, which can be mistakenly regarded as necrosis. With necrosis, the shadow of the bone is preserved; a sequestrum is visible against its background, which can shift over time. When a joint is involved, the joint space narrows and the articulating surfaces of the bones become uneven.
- Lab tests. Purulent inflammation is accompanied by characteristic laboratory changes: increase in ESR, leukocytosis with a shift to the left, the presence of rheumatoid factor in the blood, C-reactive protein and antistreptolysin-O. Culture of wound discharge indicates the presence of pyogenic microflora and allows one to determine its sensitivity to antibiotics.
Treatment of bone panaritium
Treatment is only surgical. The location of the incision is selected taking into account the location of the fistula and X-ray data, based on the principles of maximum preservation of the functions and working surface of the finger. Typically, the opening of the panaritium is carried out by expanding the fistula tract. Both bone sequestra and the affected surrounding tissue are subject to excision. Removal of non-viable areas has its own characteristics associated with the insignificant volume of tissue in this area. When excising fiber, do not use a scalpel or ordinary scissors; the modified segments are grabbed by a mosquito, pulled towards you, and section by section is carefully cut off with pointed scissors.
Then they begin to remove the affected bone, which should also be extremely economical. Loose bone sequestra are excised. Separately located healthy areas that have retained contact with the periosteum are left even with an uncertain prognosis for their recovery. The wound is washed with a tight stream hypertonic solution from a syringe. Subsequently, dressings are carried out, general antibiotic therapy is supplemented by the introduction of antibiotics into the source of inflammation.
If there are no prospects for restoration of the phalanx, or there is a threat of further spread of infection, amputation or disarticulation of the finger is performed. When making a decision to amputate the first finger, it is taken into account functional value, if possible, they try to preserve every millimeter of length even with the threat of deformation and ankylosis, since a deformed or immobile finger is often more functional than its stump. If there is significant damage to the remaining fingers, the level of amputation is chosen so as to create a functional stump with a working surface free of scars.
Prognosis and prevention
The prognosis of bone panaritium is determined by the prevalence of the osteomyelitic process, the preservation of the periosteum and the degree of involvement of surrounding structures. With timely treatment of marginal sequestration, the outcome is usually favorable. In other cases, in the long term, shortening and/or impaired mobility of the finger is possible, scar deformities. Prevention consists of preventing industrial and household injuries, using protective equipment (gloves) when working with irritating substances, timely contacting a surgeon in case of inflammation and injuries of the fingers, adequate opening and drainage of other forms of panaritium.
Main symptoms:
- Pain in the affected area
- Rave
- Ulcer under the nail
- Fever
- Impaired consciousness
- Finger dysfunction
- Malaise
- Limitation of joint mobility
- Swelling in the affected area
- Finger in a bent position
- Redness of the skin at the site of the lesion
- The appearance of bubbles with liquid
- Fistula with back side finger
- Feeling broken
Panaritium of the finger – acute infectious inflammation soft tissues of the fingers. The pathology progresses due to the entry of infectious agents into these structures (through damaged skin). Most often, the progression of the pathology is provoked by streptococci and staphylococci. At the site of bacterial penetration, hyperemia and edema first appear, but as the pathology develops, an abscess forms. In the initial stages, when the first symptoms appear, panaritium can be eliminated using conservative methods. But if an abscess has already formed, then in this case There is only one treatment - surgery.
The peculiarities of the location of the soft tissues on the hand contribute to the fact that the purulent process can progress not only superficially, but also spread in depth - to the bones, tendons and articular joints. In this case, more complex and difficult to treat forms of panaritium arise. It is important to immediately consult a qualified doctor when the first symptoms appear to avoid the development of dangerous complications. Most often, panaritium is diagnosed in a child, or in people from the age group from 20 to 50 years. The most common location for an abscess is the 1st, 2nd and 3rd finger right hand. It is noteworthy that the development of this pathological process can be facilitated by both exogenous and endogenous factors.
Etiology
Felon in humans occurs due to the penetration of infectious agents through damaged skin. Most often the disease is provoked by the following pathogenic microorganisms:
- fungal microorganisms;
They can enter the human body through:
- microcracks;
- cuts;
- splinters;
- abrasions;
- burrs;
- scratches.
The risk of developing panaritium is much higher in persons:
- having a history of;
- those suffering from immunodeficiency;
- having pathologies of blood circulation in the hand;
- suffering from or.
Varieties
Skin felon. ICD 10 code - L03.0. The same code is also inherent in subcutaneous and subungual panaritium. An abscess forms on the back of a toe or hand. Due to the pathogenic activity of microorganisms, purulent exudate gradually begins to accumulate under the epidermis in this place.
Gradually, a bubble forms at the site of the lesion, inside of which there is a yellow-gray liquid (this is pus). Sometimes the exudate may also contain an admixture of blood. The skin located in close proximity to the pathological formation is hyperemic and swollen. The affected area hurts very much. If the bubble begins to grow, then this is a sure sign that the purulent process has spread to tissues located deeper.
Subcutaneous panaritium. In this case, the formation is localized under the epidermis of the fingers on the palmar surface. In this area, the skin is very dense and calluses often form on it (due to physical labor). It is because of them that the accumulated purulent exudate during subcutaneous felon does not break out, but penetrates into deeper tissues. If panaritium is not treated urgently, tendons, articular joints and bone structures will be involved in the pathological process.
Nail or subungual panaritium. The affected area is the soft tissue that is located under the nail. Most often, subungual felon develops after a splinter gets under the plate and is pulled out untimely. Or, on the contrary, they pulled it out, but did not fully disinfect the wound.
In medicine, this painful condition is also called paronychia. A purulent blister forms in close proximity to the nail fold. The main reason for its progression is traumatic manicure.
This condition in medicine is also called purulent arthritis of the articular joint that connects 2 fingers. The formation of articular panaritium occurs after trauma to the hand, as a result of which infectious agents penetrated into the joint cavity. This form can also become a complication subcutaneous variety an illness when pus penetrates into deep tissues. In case of failure to provide qualified assistance, the mobility of the articular joint may subsequently decrease. ICD 10 code - M00.0.
Osteoarticular form. This is a complication of the joint form if it is not diagnosed and treated completely. The purulent process from the articular joint spreads to the bone structures of the hand.
Bone panaritium. This form may begin to progress as a complication of the articular form, but its primary development is also possible. Usually, bone panaritium progresses after undergoing open fracture. ICD 10 code - M86.1.
Tendon panaritium. This condition also has another name -. A purulent process that affects the tendons, on this moment considered the most severe form illness. It is very difficult to cure tendon panaritium, and even after full treatment there is no certainty that the motor function of the hands will be preserved.
Symptoms
All varieties of this disease have their own Clinical signs. But there is a group of symptoms that are characteristic of all forms of felon:
- pain syndrome in the affected area. Usually it is pulsating in nature;
- hyperemia skin;
- swelling at the site of suppuration;
- dysfunction of the fingers. A person cannot bend them, as strong painful sensations;
Symptoms of the skin form:
- hyperemia of the skin in the affected area;
- the formation of a pathological bubble, inside of which there is exudate. It may be bloody or purulent;
- at the early stage of progression of the pathology, the pain syndrome is not pronounced, but gradually it becomes very strong and acquires a pulsating character;
- stem lymphangitis;
- weakness;
- brokenness;
- hyperthermia.
Symptoms of the periungual form:
- at an early stage, edema and hyperemia are local in nature. Gradually the process spreads to the entire nail fold;
- the formation of an abscess that can be easily seen through the thin epidermis in a given location;
- severe pain syndrome. The pain is especially severe at night;
- sleep disturbance;
- hyperthermia.
Symptoms of the subungual form:
- formation of an abscess under the nail;
- intense pain syndrome;
- malaise;
- weakness;
- brokenness;
- sleep disturbance;
- swelling of the nail phalanx;
- purulent exudate can be seen under the nail;
- hyperthermia.
Symptoms of subcutaneous felon:
- at an early stage, slight redness and mild pain are observed at the site of infection entering the body;
- As the subcutaneous panaritium progresses, the pain syndrome intensifies and becomes pulsating;
- the affected finger swells;
- chills;
- hyperthermia;
- weakness;
- brokenness.
Symptoms of bone panaritium:
- at the early stage of progression of bone panaritium, a clinical picture of the subcutaneous form is observed, but all the symptoms of the disease are more pronounced;
- severe pain due to which a person cannot sleep;
- the phalanx with the abscess increases in size. Characteristic sign this form of the disease is a flask-shaped appearance of the affected finger;
- the skin is hyperemic and has a slight cyanotic tint. Upon visual inspection, its shine is noted;
- the affected finger is in a half-bent position. The patient does not have the opportunity to straighten it completely, since when trying to do this, acute pain occurs;
- chills;
- fever.
Signs of articular form:
- pain in the area of the affected joint, as well as severe swelling;
- decreased range of motion;
- when palpating the site of the lesion, tension in the capsule of the articular joint can be noted;
- formation of a fistula on the back of the finger.
Signs of tendon panaritium:
- uniform swelling of the affected finger;
- severe pain syndrome;
- There is sharp pain along the tendons;
- the finger is slightly bent;
- hyperemia is usually not observed;
- weakness;
- decreased appetite;
- hyperthermia;
- disturbance of consciousness;
- rave.
Therapeutic measures
How to treat panaritium can only be said qualified doctor, after a thorough inspection. Usually they resort to two methods - conservative and operative. If the disease progresses no more than two days, then you can try to cope with the purulent process conservative methods– using semi-alcohol dressings, antiseptic pharmaceuticals, taking antibiotics, etc. If the purulent process is in an advanced stage, then in this case there is only one treatment - surgical intervention.
Treatment of felon at home can be carried out using various means traditional medicine. But you can use any prescriptions only after consulting your doctor and obtaining his permission to do so. The most effective folk remedies with felon are:
- medicinal bandage with onions;
- beet compress;
- Castor oil;
- aloe leaf;
- alcohol tincture of calendula;
- celandine bath.
With bone panaritium, the inflammatory process involves bone. Most often, this form of panaritium is a consequence bad treatment subcutaneous felon (secondary bone felon), although primary bone damage is also possible with deep wounds and suppuration of subperiosteal hematomas.
The clinic of primary and secondary bone panaritium has significant differences. With the primary lesion, the development of bone felon, like subcutaneous felon, is accompanied by intense throbbing pain in the affected phalanx. The finger is in a half-bent position, movements in the interphalangeal joints are sharply limited and painful. On palpation, the entire phalanx is painful (in contrast to the subcutaneous panaritium). General state the patient suffers to a greater extent than with other types of panaritium. Sometimes chills appear. Body temperature rises to 39–40˚.
The development of secondary bone panaritium takes at least 7–10 days. In the first days, a characteristic clinical picture is observed due to the primary lesion. Then the pain subsides, the fever drops to low-grade, but pus continues to discharge from the wound. When inspecting a wound with a probe, a narrowed bone devoid of periosteum is usually identified.
IN initial stage of the bone panaritium, spotty osteoporosis and foci of bone tissue resorption are determined on radiographs. Signs of marginal destruction on the nail phalanx appear on days 12–14, on the main and middle ones – 18–20 days from the onset of the disease. At a later date, significant destruction is observed, up to the complete destruction of the phalanx.
Treatment of bone panaritium is only surgical. Patients with acute pain and fever will be treated with emergency hospitalization; in the absence of signs of acute inflammation and significant periods of illness - planned hospitalization for several days.
IN early stages, with limited bone destruction, it is possible to perform organ-saving operations (marginal resections, bone curettage). If there is significant bone destruction, amputation is necessary in most cases.
Articular felon
The inflammatory process during articular felon involves the interphalangeal or metacarpophalangeal joint and soft periarticular tissues. In some cases, the inflammatory process affects the articular ends of the phalanges and then osteoarticular panaritium develops.
Articular felon, like bone felon, can be primary and secondary. Primary damage occurs with penetrating joint injuries. Especially dangerous in this regard are bruised wounds on the dorsal surface that occur when struck with a fist. Among them, the so-called denticular injuries (from the Latin dens - tooth, ictus - push, blow), which occur when a fist hits the teeth, deserve special attention. Secondary articular felon is less common and develops as a complication of other forms of felon, as well as as a result of technical errors (damage to the articular capsule of the joint) made during surgery for any felon.
In the clinical picture of articular panaritium, the pain reaction constantly increases over time and becomes intense. The pain is initially localized in the area of the affected joint, and then spreads to the entire finger and hand. The swelling circumferentially covers the entire joint. When a significant amount of serous or purulent contents appears in the joint cavity, the finger takes on a spindle-shaped shape and is fixed by the patient in a semi-bent state. Axial load and attempts at passive movements are sharply painful. The patient loses sleep and appetite, weakness, chills appear, and body temperature rises to 38–39˚.
X-rays of the finger usually reveal thickening of the soft tissue in the circumference of the affected joint, the phenomenon of moderate osteoporosis of the bone parts involved in the formation of the joint, deformation of the gap occurs in the presence of exudate in the joint cavity and its narrowing when the articular cartilage is destroyed.
With the development of osteoarticular panaritium, the pain usually decreases, and the abscess naturally or surgically begins to drain outward. A characteristic symptom is the appearance of lateral mobility in the affected joint, which can sometimes lead to bone crepitus.
Treatment of articular felons should only be carried out by a surgeon in a hospital setting. Indications for hospitalization are the same as for bone panaritium. IN early dates For diseases of the joint, puncture of the joint is performed, and in later cases, through drainage and washing of the joint cavity. In case of osteoarticular panaritium, joint resections are performed, and in case of significant bone destruction, amputations are performed.
An important task of a general practitioner is the rehabilitation of patients after hospital treatment. In general, it is carried out in the same way as with tendon panaritium, however, in this case it is impossible to force an increase in the range of movements, since foci of dormant infection may remain in the affected area, which can be activated under the influence of exercise therapy and physiotherapy. In some cases, the use of antimicrobial drugs after discharge from the hospital, or local antibacterial therapy (electrophoresis with antibiotics) is indicated.
